5 points to explain (and reverse) the decline in childhood vaccination in Brazil

Brazil has faced a continuous decline in childhood vaccination coverage over the past ten years. This is demonstrated by the VacinaBR 2025 Yearbook, a report by the Instituto Questão de Ciência (IQC) with support from the Brazilian Society of Immunizations (SBIm) and in partnership with the United Nations Children's Fund (UNICEF). Among the most striking data in the recently released document is the fact that none of the vaccines in the national schedule met the National Immunization Program (PNI) targets in all Brazilian states in 2023.

Furthermore, there are regional and municipal inequalities: even in states with good immunization rates, there are variations between municipalities, creating what researchers call “pockets of low coverage.”

What are the main factors explaining this decline? For pediatrician Eduardo Jorge da Fonseca Lima, president of the Scientific Department of Immunization of the Brazilian Society of Pediatrics (SBP) and coordinator of the Technical Chamber of Pediatrics of the Federal Council of Medicine (CFM), there is no single answer. "What we've been experiencing since 2015 or so is a kind of 'perfect storm.' It's a multifaceted crisis, where several problems have occurred simultaneously. Misinformation has exploded, public confidence has diminished... We've had issues with shortages of some vaccines, and the routine at health clinics often doesn't help parents' lives. And, of course, the COVID-19 pandemic has come to disrupt everything," he summarizes.

" The result is this flashing alarm bell, with the real risk of seeing diseases that were previously controlled, or even eliminated, return to circulation," adds the expert. One of the most emblematic examples is the increase in measles cases worldwide. According to UNICEF, the number of measles cases increased 20% from 2002 to 2023. In an exclusive interview with IstoÉ, Eduardo Jorge da Fonseca Lim lists five points to understand and reverse the problem. Check it out.

Covid-19 pandemic

IstoÉ: How has the pandemic affected childhood vaccination in general?

Eduardo Jorge da Fonseca Lima: The global COVID-19 health crisis had a profound and negative impact on routine vaccination. During the peak of the pandemic, fear of contamination in health services, restrictions on movement, and the overload of health systems, which had focused their efforts on combating the coronavirus, led to the interruption and postponement of childhood immunization. Furthermore, the intense and politicized public debate surrounding COVID-19 vaccines ended up impacting the perception of vaccines in general, increasing distrust among a portion of the population.

Fake news

IstoÉ: How does fake news impact trust in vaccines?

Eduardo Jorge da Fonseca Lima: The impact is achieved through specific tactics such as emotional appeal and fear-mongering. Fake news rarely uses rational arguments. It exploits fear, parents' primary emotion when it comes to their children's health. Narratives about deaths, serious side effects, and illnesses supposedly caused by vaccines, accompanied by dramatic images and reports, often false or taken out of context, are more impactful than statistical efficacy data. Pseudoscientific language and oratory skills lend an air of legitimacy, and, furthermore, disinformation content frequently uses scientific jargon, cites fraudulent studies—such as the now-debunked article linking the MMR vaccine to autism—or distorts legitimate research data. This creates a "fog of doubt" that confuses the public, making the lie seem as plausible as scientific truth.

IstoÉ: Did things get worse after the pandemic?

Eduardo Jorge da Fonseca Lima: It got much worse. What we saw was a tsunami of information and lies like never before. Covid-19 became the center of an absurd political and ideological dispute. When important leaders began to question science and attack health institutions, they gave the anti-vaccine movement a legitimacy it never had before. The distrust planted against the Covid vaccine "spilled over" to all the others. Parents who began to doubt the Covid vaccine began to question the entire children's calendar.

Change in risk perception

IstoÉ: Is there still a change in the perception of risk in relation to preventable diseases?

Eduardo Jorge da Fonseca Lima: Absolutely. We, as a society, have lost the collective memory of what these diseases represent. It's the "paradox of success." Entire generations grew up, fortunately, without seeing a child with polio, without hearing about a measles outbreak that left neurological damage. The image of "iron lungs" for polio victims has become an old, black-and-white photograph. Immunization programs were so effective in Brazil and around the world that they eliminated or drastically reduced the circulation of diseases that, in the past, caused panic, after-effects, and death. As a result, the population became complacent.

And then the focus of fear shifts. As a pediatrician in the vaccination room, I see this every day. Parents' fear has shifted from the disease, which is invisible, to the vaccine, which is concrete. Our challenge today is to communicate a risk that people no longer see. Therefore, today, in 2025, we must constantly remind ourselves that polio and measles viruses haven't disappeared from the world; they've simply been kept under control by high vaccination rates.

Logistics and supply

IstoÉ: Did logistical problems, such as a lack of doses and restricted opening hours at health centers, also influence these negative rates in recent years?

Eduardo Jorge da Fonseca Lima: Yes. Sometimes, the problem isn't that the parent doesn't want to get vaccinated: they want to, but can't. Think about the routine of a working family. How can a parent who clocks in take their child to get vaccinated at a clinic that closes at 5 p.m.? It's practically impossible without having to miss work. And add to that the frustration of, on the day you do manage to go, hearing that "vaccine X is out of stock." We have, indeed, had periods of instability in the supply of some vaccines. A family that goes to the clinic once or twice and can't find the dose simply gives up. Although the National Immunization Program (PNI) is one of the best in the world, Brazil has faced periods of instability in the supply of some vaccines in recent years. There have been reports and confirmations of shortages or irregular supplies of important vaccines, such as the chickenpox vaccine, in several regions of the country. Surveys conducted with municipal managers, such as those conducted by the National Confederation of Municipalities (CNM), confirmed the lack of doses in thousands of cities.

The impact is felt at the frontline, even though the Ministry of Health reports that supplies are regularized at the federal level. Distribution problems to states and, especially, municipalities can cause occasional shortages. I also highlight other issues such as information systems where Failures and instabilities in vaccine registration systems (such as e-SUS PNI) can make it difficult to control who has been vaccinated and which doses are missing, in addition to generating inaccurate coverage data.

While misinformation convinces some people not to get vaccinated, logistical problems prevent others, who are often willing and aware of the importance of vaccines, from protecting their children.

How to change the scenery

IstoÉ: What measures can reverse the decline in childhood vaccination in the country?

Eduardo Jorge da Fonseca Lima: Starting with flexible hours. It's a measure of respect for the citizen. Offering vaccinations at night, on Saturdays, Sundays, or in busy places like shopping malls, as we've seen in Recife, for example, removes an obvious barrier for working families.

Vaccination in schools is another masterstroke. It brings the solution to the problem. It makes parents' lives easier, ensures a large number of children are reached at once, and transforms schools into health education hubs, combating misinformation at its root.

At the same time, the link with Bolsa Família is a powerful public health tool. It's not a punishment; it's a shared responsibility. It's the State saying: "I offer the benefit and the vaccine, and the family fulfills its duty to protect the health of their children and the entire community." It makes it clear that vaccination is not only a right, but also a duty of parents toward the health of their children and the entire community.

IstoÉ: How to restore public confidence in vaccines?

Eduardo Jorge da Fonseca Lima: It's impossible to restore trust without a strong counteroffensive against fake news. This includes clear and massive government communication campaigns, partnerships with social media platforms to take down false content, and training healthcare professionals to become active agents in debunking rumors during consultations.

The government also needs to ensure a continuous supply of all vaccines on the schedule, preventing parents from missing trips to the health center, which generates frustration, discourages return visits, and undermines the program's credibility. In short, the solution to the vaccine crisis isn't a one-size-fits-all solution. We need a combination of actions to make vaccination easier, more convenient, and, above all, more reliable.